SMQT Pharmacy and Medication Services 5 — Questions and Answers
Question 1: A surveyor observes that a facility has no written policy for disposing of unused or expired controlled substances. What is the most appropriate survey finding?
- Minor finding, as verbal policies are acceptable for controlled substances
- Deficiency, because DEA and state regulations require facilities to have documented procedures for controlled substance disposal (Correct answer)
- Not a deficiency if the drugs are being returned to the pharmacy
- Acceptable practice as long as a pharmacist witnesses all disposals
Correct answer: Deficiency, because DEA and state regulations require facilities to have documented procedures for controlled substance disposal
DEA regulations and state pharmacy laws require facilities to maintain written policies for the disposal of controlled substances, including return, destruction, or DEA Form 41 procedures.
Question 2: Which action by a surveyor best addresses a concern about residents' rights related to medications in a long-term care setting?
- Confirming medications are locked at all times
- Interviewing residents about whether they were informed of their medications and possible side effects (Correct answer)
- Reviewing only the pharmacist's monthly report
- Observing only the medication administration process
Correct answer: Interviewing residents about whether they were informed of their medications and possible side effects
Residents have a right to be informed about their medications; surveyor interviews can reveal whether staff are educating residents about drug names, purposes, and potential side effects.
Question 3: A facility pharmacist identifies that a resident has been on a proton pump inhibitor (PPI) for three years without documented clinical indication. What survey concern does this raise?
- Controlled substance misuse
- Potentially unnecessary drug use requiring documented indication and ongoing clinical review (Correct answer)
- A dietary supplement oversight issue
- Violation of the resident's right to refuse medication
Correct answer: Potentially unnecessary drug use requiring documented indication and ongoing clinical review
Long-term PPI use without documented indication or periodic review is flagged during surveys as potentially unnecessary drug use under 42 CFR §483.45.
Question 4: When a surveyor reviews a hospital's high-alert medication policy, which class of drugs would they most expect to see listed?
- Antacids and vitamins
- Anticoagulants, concentrated electrolytes, insulin, and opioids (Correct answer)
- Antihistamines and topical corticosteroids
- Laxatives and stool softeners
Correct answer: Anticoagulants, concentrated electrolytes, insulin, and opioids
ISMP's high-alert medication list includes anticoagulants, concentrated electrolytes, insulin, opioids, and other drugs with a high risk of causing significant patient harm if misused.
Question 5: A nursing facility uses a single shared medication cart key kept at the nurses' station accessible to all staff. What survey deficiency does this most likely represent?
- Fire safety violation
- Inadequate controlled substance security, as medications must be accessible only to authorized personnel (Correct answer)
- Staffing ratio violation
- Dietary services deficiency
Correct answer: Inadequate controlled substance security, as medications must be accessible only to authorized personnel
Federal regulations require that medications, especially controlled substances, be stored securely with access limited to authorized licensed personnel.
Question 6: A surveyor notes that a physician wrote an order for 'aspirin as needed for pain' without specifying dose, route, or frequency. How should this finding be evaluated?
- Acceptable because aspirin is an over-the-counter medication
- A deficiency because medication orders must include dose, route, frequency, and indication to be complete and safe (Correct answer)
- Non-issue if the pharmacist fills it correctly
- Only a problem if the resident is harmed
Correct answer: A deficiency because medication orders must include dose, route, frequency, and indication to be complete and safe
Complete medication orders must specify the drug name, dose, route, frequency, and indication; incomplete orders create ambiguity that can lead to medication errors.
Question 7: During a hospital survey, a surveyor finds that a patient received a double dose of warfarin because the day-shift and night-shift nurses both administered the evening dose. Which system failure does this best illustrate?
- Inadequate hand hygiene compliance
- Failure of medication administration documentation and handoff communication (Correct answer)
- Poor dietary coordination with pharmacy
- Insufficient physician oversight
Correct answer: Failure of medication administration documentation and handoff communication
Double dosing due to a shift change indicates a failure in real-time medication administration documentation and structured handoff communication between nurses.
SMQT Pharmacy and Medication Services 5
A surveyor observes that a facility has no written policy for disposing of unused or expired controlled substances.
What is the most appropriate survey finding?